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  • A Dissertation on

    HAEMATOLOGICAL MANIFESTATIONS IN

    CHRONIC OBSTRUCTIVE LUNG DISEASE

    IN RELATION TO FEV1

    COIMBATORE MEDICAL COLLEGE HOSPITAL

    Dissertation Submitted to

    THE TAMILNADU Dr.M.G.R. MEDICAL UNIVERSITY

    CHENNAI - 600 032

    With partial fulfillment of the regulations

    for the award of the degree of

    M.D. GENERAL MEDICINE

    BRANCH-I

    COIMBATORE MEDICAL COLLEGE,

    COIMBATORE

    APRIL 2015

  • CERTIFICATE

    Certified that this is the bonafide dissertation in “HAEMATOLOGICAL

    MANIFESTATIONS IN CHRONIC OBSTRUCTIVE LUNG

    DISEASE IN RELATION TO FEV1” done by Dr. GOWRI SANKAR.

    M and submitted in partial fulfillment of the requirements for the Degree

    of M.D., General Medicine, Branch I of The Tamilnadu Dr. M.G.R.

    Medical University, Chennai.

    Date: Guide, Professor & Chief

    Medical Unit III

    Date: Professor & Head

    Department of Medicine

    Date: Dean

    Coimbatore Medical College

    Coimbatore

  • DECLARATION

    I solemnly declare that the dissertation titled “HAEMATOLOGICAL

    MANIFESTATIONS IN CHRONIC OBSTRUCTIVE

    LUNG DISEASE IN RELATION TO FEV1” was done by me

    from AUGUST 2013 to JULY 2014 under the guidance and supervision of

    Professor Dr. S.USHA .M.D. This dissertation is submitted to

    The Tamilnadu Dr.M.G.R. Medical University towards the partial

    fulfillment of the requirement for the award of MD Degree in General

    Medicine (Branch I).

    Place: Coimbatore Dr. GOWRI SANKAR.M

    Date:

  • ACKNOWLEDGEMENT

    I wish to express my sincere thanks to our respected

    Dean Prof. Dr.S.REVWATHY, M.D.DGO.DNB., for having allowed

    me to conduct this study in our hospital.

    I express my heartfelt thanks and deep gratitude to the Head of the

    Department of Medicine Prof. Dr. KUMAR NATARAJAN, M.D. for his

    generous help and guidance in the course of the study.

    I am extremely grateful to Prof. Dr. S. USHA, M.D., Professor of

    medicine for her continuous motivation,timely advice and valuable

    criticism which enabled me to complete the dissertation.

    I would also like to thank wholeheartedly the professor of the

    Department of Pulmonology Prof. Dr. S. KEERTHIVASAN, MD., for

    his encouragement and guidance during the study.

    I’m privileged to extend my gratitude and respect to

    Dr. R. VANI. MBBS., DTCD, and Dr. K. ANBANANTHAN, MD., the

    assistant professor of Department of Pulmonology. I’m thankful to them

    for their valuable thoughts, inspiring comments and guidance.

    I sincerely thank all Professors and Asst. Professors

    Dr. T.GEETHA M.D., Dr. P.S.RANI M.D., Dr. SIVAKUMAR. M.D.,

  • I would like to thank them for their Valuable suggestions. I’m indebted to

    them for being a constant source of inspiration.

    My sincere thanks to all my friends and post-graduate colleagues for

    their whole hearted support and companionship during my studies.

    I thank all my PATIENTS, who formed the backbone of this study,

    without whom this study would not have been possible.

  • TABLE OF CONTENTS

    S.NO TOPIC PAGE

    NO.

    1 INTRODUCTION 01

    2 OBJECTIVES OF THE STUDY 03

    3 REVIEW OF LITERATURE 04

    4 MATERIALS AND METHODS 56

    5 RESULTS 59

    6 DISCUSSION 92

    7 CONCLUSIONS 98

    8 SUMMARY 100

    9 BIBLIOGRAPHY

    10 ANNEXURES

    (i) PROFORMA

    (ii) STATISTICAL METHODS

    (iii) KEY TO MASTER CHART

    (iv) MASTER CHART

    (v) CONSENT FORM

  • LIST OF ABBREVIATIONS USED

    1. COPD - Chronic Obstructive Pulmonary Disease

    2. HB – Haemoglobin

    3. MCV - Mean Corpuscular Volume

    4. MCH - Mean Corpuscular Haemoglobin

    5. MCHC - Mean Corpuscular Haemoglobin Concentration

    6. SABA - Short-Acting Beta-Agonist

    7. SAMA - Short Acting Antimuscarninic Agent

    8. LAMA - Long-Acting Antimuscarninic Agent

    9. LABA - Long-Acting Beta-Agonist

    10.ICA - Inhaled Corticosteroids

    11. FEV1 - Forced Expiratory Volume in One Second

    12. FVC - Forced Vital Capacity

    13. WHO – World Health Organisation

  • LIST OF TABLES

    Table

    No.

    Title Page.

    No

    1 SEX DISTRIBUTION 59

    2 AGE DISTRIBUTION 60

    3 DURATION OF ILLNESS 61

    4 PLACE OF LIVING 62

    5 BODY MASS INDEX 63

    6 SMOKING HABITS AMONG THE PATIENTS

    STUDIED

    64

    7 SMOKING PACK YEARS 65

    8 OCCUPATIONAL EXPOSURE – COTTON

    MILL WORKERS

    66

    9 ENVIRONMENTAL TOBACCO SMOKE

    EXPOSURE

    67

    10 BIO MASS FUEL EXPOSURE 68

    11 PRESENTATION OF SYMPTOMS 69

    12 SIGNS ON PHYSICAL EXAMINATION 70

    13 CHEST EXPANSION MEASUREMENT 71

    14 m MRC GRADING 72

    15 FEV1 OF THE PATIENTS STUDIED 73

    16 GOLD SEVERITY OF COPD 74

    17 CHEST X RAY OF THE PATIENTS STUDIED 75

    18 PERIPHERAL SMEAR OF THE PATIENTS

    STUDIED

    76

    19 HAEMOGLOBIN OF THE PATIENTS

    STUDIED

    77

  • 20 MEAN CORPUSCULAR VOLUME OF THE

    PATIENTS STUDIED

    78

    21 MEAN CORPUSCULAR HAEMOGLOBIN OF

    THE PATIENTS STUDIED

    79

    22 MEAN CORPUSCULAR HAEMOGLOBIN

    CONCENTRATION OF THE PATIENTS

    STUDIED

    80

    23 HAEMATOCRIT OF THE PATIENTS

    STUDIED

    81

    24 COMPARISON OF AGE vs HAEMOGLOBIN 82

    25 COMPARISON OF AGE vs MCV 83

    26 COMPARISION OF AGE vs MCH 84

    27 COMPARISON OF SEX vs HAEMOGLOBIN 85

    28 COMPARISON OF SEX vs MCV 86

    29 COMPARISON OF SEX vs MCH 87

    30 DURATION OF ILLNESS vs HAEMOGLOBIN 88

    31 COMPARISON OF SMOKING WITH

    HAEMOGLOBIN

    89

    32 COMPARISON OF OCCUPATIONAL

    EXPOSURE –COTTON MILL WORKERS

    WITH HAEMOGLOBIN

    90

    33 m MRC GRADING vs HAEMOGLOBIN 91

  • LIST OF CHARTS

    Chart

    No.

    Title Page.

    No

    1 SEX DISTRIBUTION 59

    2 AGE DISTRIBUTION 60

    3 DURATION OF ILLNESS 61

    4 PLACE OF LIVING 62

    5 BODY MASS INDEX 63

    6 SMOKING HABITS AMONG THE PATIENTS

    STUDIED

    64

    7 SMOKING PACK YEARS 65

    8 OCCUPATIONAL EXPOSURE – COTTON

    MILL WORKERS

    66

    9 ENVIRONMENTAL TOBACCO SMOKE

    EXPOSURE

    67

    10 BIO MASS FUEL EXPOSURE 68

    11 PRESENTATION OF SYMPTOMS 69

    12 SIGNS ON PHYSICAL EXAMINATION 70

    13 CHEST EXPANSION MEASUREMENT 71

    14 m MRC GRADING 72

    15 FEV1 OF THE PATIENTS STUDIED 73

    16 GOLD SEVERITY OF COPD 74

    17 CHEST X RAY OF THE PATIENTS STUDIED 75

    18 PERIPHERAL SMEAR OF THE PATIENTS

    STUDIED

    76

    19 HAEMOGLOBIN OF THE PATIENTS

    STUDIED

    77

  • 20 MEAN CORPUSCULAR VOLUME OF THE

    PATIENTS STUDIED

    78

    21 MEAN CORPUSCULAR HAEMOGLOBIN OF

    THE PATIENTS STUDIED

    79

    22 MEAN CORPUSCULAR HAEMOGLOBIN

    CONCENTRATION OF THE PATIENTS

    STUDIED

    80

    23 HAEMATOCRIT OF THE PATIENTS

    STUDIED

    81

    24 COMPARISON OF AGE vs HAEMOGLOBIN 82

    25 COMPARISON OF AGE vs MCV 83

    26 COMPARISION OF AGE vs MCH 84

    27 COMPARISON OF SEX vs HAEMOGLOBIN 85

    28 COMPARISON OF SEX vs MCV 86

    29 COMPARISON OF SEX vs MCH 87

    30 DURATION OF ILLNESS vs HAEMOGLOBIN 88

    31 COMPARISON OF SMOKING WITH

    HAEMOGLOBIN

    89

    32 COMPARISON OF OCCUPATIONAL

    EXPOSURE –COTTON MILL WORKERS

    WITH HAEMOGLOBIN

    90

    33 m MRC GRADING vs HAEMOGLOBIN 91

  • LIST OF FIGURES

    Figure

    No.

    Figure Title Page No.

    1 TEOFILO BONET 04

    2 GIAMBATISA MORGAGNI 04

    3 JOSEF LEOPOLD AUENBRUGGER 05

    4 TREATISE OF DISEASES OF THE CHEST 05

    5 SHADOW IMAGE OF JOHN HUTCHINSON

    AND HIS SPIROMETRY

    05

    6 DEVELOPMENT OF THE RESPIRATORY

    SYSTEM

    08

    7 MAJOR PHASES OF RESPIRATORY

    DEVELOPMENT

    09

    8 BRONCHI AND THEIR DIVISIONS 12

    9 BRONCHOPULMONARY SEGMENTS 13

    10 STRUCTURES OF THE LUNGS /

    GENERATIONS

    14

    11 PULMONARY CIRCULATION 16

    12 LUNG VOLUMES AND CAPACITIES 18

    13 RISK FACTORS OF COPD 24

    14a. THE OVERLAP OF COPD AND ASTHMA 29